Friday, April 2, 2010

Mrs. Old has numb feet. She lives in a nursing home. I've never seen her before.

Today her new nursing home doctor was rounding on her. He saw in her chart that she's had numb feet for over 10 years, but has never seen a neurologist for them. She also has Alzheimer's disease, so can't tell him much.

At 10:45 this morning Dr. Newbie called my office to see if I would see her. Because of transportation issues, they couldn't get her here until next Thursday. So he didn't make an appointment for her.

At 1:45 the hospital called me. Dr. Newbie actually admitted her for 10 years of foot numbness and 5 years of Alzheimer's disease, so she could see me before next Thursday.

I refused the consult. I am NOT going to be a party to such an insane waste of money.

29 comments:

Anonymous
said...

Are you sure it was just for the feet? It's the Friday before a holiday, maybe the nursing home talked him into it due to some other special need...she's either sweet as pie, and I'm overly cynical, or she's at least a "4" on your crazy scale, and it's a good thing you declined the consult!

What a buffoon! Did the recent debates about the astronomical costs of healthcare completely pass him by? He is, no doubt, part of the problem that has led the rest of us to this mess. Doctors ordering unneeded expensive tests or admissions to hospitals. Thank you very much, Dr. Buffoon, for screwing it up for the rest of us.

I got the office on Wednesday, knowing that my doc was on call on Tuesday. There was a cryptic note on the desk about some such lip laceration. So, I called up to surgery to see if he had scheduled something I didn't know about. Nope. He did it in the office. Because the surgery fee was going to be unmanageable for the patient who had no insurance. Yep. I love him. They called in the consult because they wanted to jack up the hospital charges. He told them - "Send them to my office." And they were all, "Your office is closed." Ha! Beating the system gives us all kinds of giggles.

And top of the stupid he has the meanness of spirit. The WORST place for this patient is the hospital--her dementia is likely to progress more rapidly now. The idiot should simply have left her in peace.

I ventured into your territory today. Man at the gym, looking fit, complained (after racketball game), "I am just not as fast as I used to be. After my surgery I noticed the difference. The surgeon said nothing he did would account for the problem."

Me: "How old are you?"

Him: "75. I plan to live to at least 85."

Me: "What kind of surgery did you have?"

Him: "Colon cancer. No sign of return so far."

Me: "Have you seen a neurologist?"

Him: "No. Maybe I should..."

I will never see him again. I am not asking medical advice. I don't know where you are or your real name. Should he see a neurologist? Just curious.

I'm an ER nurse. I know without you mentioning it that Dr. Newbie had her "admitted" through the ED, which meant Mrs. Old took up a valuable ED bed and the time and energy of ED staff that could have been better spent on the sick. Not to mention the loss of an ambulance while they transported her, and if he had the nursing home staff call in with "numb feet" they would have sent out an engine company as well in case she was having an acute stroke. For those of you who've languished for hours in an ED, know that this is extremely common for primary care doctors to do and has a noticeable impact on our ability to care for acutely ill people. It makes me wish those doctors would come see us with an excruciating kidney stone, and we'll give 'em a corner chair in the lobby for a few hours. Guess I'm kinda grumpy too. :)

That ambulance ride alone is going to cost someone about $800. And if they find a neuro to consult on her in the hospital, that'll be at least another $250. Just having a bed? Probably $1,000. So who the hell is going to pay for all that? Not to mention the testing?

And didn't the guy learn how to do simple neuro testing during medical school? Or has be been walking around for the past 10+ years using the filament on the other side of his reflex hammer to poke himself in the eye?! How do idiots like that even get IN to medical school?!

Oh, wait, let me guess--the LOL in NAD also has diabetes, right?! I think we should all chase this guy down with our reflex hammers, STAT.

Hmmmm....makes me wonder if Fox News might critique your decision as an attempt to ration health care for this poor senior. If the patient's doctor thought that she needed to go to the hospital, then who are you or anyone else to decide that she shouldn't go...ugh!!

Alas, if we all used an ounce of common sense and had a good dose of respect for the resources we are consuming, we wouldn't be in this MESS.

Hey, not all primary care docs are bad - remember, generalizations don't apply to everyone. I hear these awful stories and I'm so glad I live and work where I do (ah, lovely small town WI). The health care in other places sounds atrocious!!

Although when I'm rounding at the nursing home - I screen everyone for numb feet and then send them straight to the ED if necessary. That's a medical emergency, especially when present for over 5 years. You learn that first year of med school right away.

Dr Grumpy, I just recently discovered your hilarious blog - thank you for making me laugh so hard I snorted orange juice all over my keyboard!

I've been back-tracking through your posts and I really wanted to ask you - how do you post the patient funnies? Do you keep this blog secretly open on your computer and type it in between consults? Or do you remember it all (well you're a neurologist, you'd have a pretty damn good memory) and then type it all up at home?

Keep it coming!

And thank you also for making me slightly paranoid about working with dementia patients when I graduate in 2 years....

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